Somebody Get Me A Doctor
Imagine! offers two Kaiser plan options, a DHMO Plan and a Multi-Choice Point of Service (POS) Plan. Benefits and rates are different between the two medical plan offerings, so please review the benefit highlights and rate sheet to determine which program best suits your and your family’s needs.
Plan Highlights
DHMO
The DHMO plan offers extensive coverage within Kaiser Facilities. Members pay a flat copay for many basic services. Some services require a deductible and coinsurance. Lab, X-ray and Pharmacy services are located within each facility. Under this plan, out-of-network benefits are not covered. Members must visit a Kaiser doctor in a Kaiser facility to obtain benefits (except in some life or limb threatening circumstances).
Multi-Choice POS (Buy-Up Plan)
The Multi-Choice offers a more flexible plan for members who would like to access physicians outside of Kaiser. Under this plan, you can use Kaiser facilities, as well as some doctors outside of the Kaiser network.
| Kaiser DHMO | Kaiser Multi-Choice POS (Buy-Up Plan) | |||
| In-Network | Kaiser POS | POS In-Network | Out-of-Network | |
| Deductible (Individual/Family) | $250/$500 | $500/$1,500 | $500/$1,500 | $1,000/$3,000 |
| Out-of-Pocket* (Individual/Family) | $2,250/$6,750 | $3,000/$6,000 | $3,000/$6,000 | $4,000/$12,000 |
| Office Visit Copay | $25 Primary $40 Specialist | $25 Primary $40 Specialist | $25 Primary $40 Specialist | Deductible + 40% |
| Preventive Care (Screenings and Immunizations) | 100% no copay | 100% no copay | 100% no copay | $70 copay |
| Hospital Admission | Deductible + 20% | Deductible + 20% | Deductible + 20% | Deductible + 40% |
| Outpatient Surgery** | Deductible + 20% | Deductible + 20% | Deductible + 20% | Deductible + 40% |
| Mental/Behavioral Health (Outpatient/Inpatient) | $25 / Deductible + 20% | $25 / Deductible + 20% | $25 / Deductible + 20% | Deductible + 40% / Deductible + 40% |
| Urgent Care Copay | Deductible + 20% | Deductible + 20% | Deductible + 20% | Deductible + 40% |
| Emergency Room Copay | Deductible + 20% | Deductible + 20% | Deductible + 20% | Deductible + 20% |
| Chiropractic Benefit (20 visits per year) | $25 | $25 | $25 | Not Covered |
| Acupuncture Benefit (20 visits per year) | $25 | $25 | $25 | Not Covered |
| Vision Benefit | $25 | $25 | Kaiser Only | Kaiser Only |
| Retail Drugs Generic Preferred Non-Preferred Specialty | $20 $40 Not covered 20% coinsurance (to$250) | $25 $40 50% coinsurance 20% coinsurance (to$250) | $30 $45 50% coinsurance 20% coinsurance (to$250) | $30 $45 50% coinsurance 20% coinsurance (to$250) |
| Mail Order Generic Preferred Non-Preferred Specialty | $40 $80 Not covered 20% coinsurance (to$250) | $50 $80 50% coinsurance 20% coinsurance (to$250) | $60 $90 50% coinsurance 20% coinsurance (to$250) | Not covered |
| *Out-of-Pocket maximum includes in-network deductible, medical copays and prescription drug copays. **Outpatient Surgery cost share will differ depending upon where the surgery takes place. |
||||
Contribution Rates
| DHMO (Base Plan) Cost per Month | |||
|---|---|---|---|
| Total Monthly Premium | Full-Time Employee | Part-Time Employee | |
| Employee Only | $579.38 | $57.94 | $289.69 |
| Employee + Spouse | $1,164.56 | $350.53 | $874.87 |
| Employee + Child(ren) | $1,071.86 | $304.18 | $782.17 |
| Employee + Family | $1,645.44 | $590.97 | $1,355.75 |
| POS (Buy-up Plan) Cost per Month | |||
|---|---|---|---|
| Total Monthly Premium | Full-Time Employee | Part-Time Employee | |
| Employee Only | $778.70 | $257.26 | $489.01 |
| Employee + Spouse | $1,565.18 | $751.15 | $1,275.49 |
| Employee + Child(ren) | $1,440.59 | $672.91 | $1,150.90 |
| Employee + Family | $2,211.49 | $1,157.02 | $1,921.80 |
What We Don’t Know Can Hurt Us
Prevention and early detection is key to your long-term health. At Imagine!, we believe in preventive and routine care and encourage your wellness participation through plan design. The Imagine! Medical Plans covers most preventive testing, routine physicals and immunizations at 100%.
Below are general guidelines published by the AMA of just some of the adult preventive testing you should consider, and the appropriate age to have them.
| Test | Age |
|---|---|
| Lipid Screening | Every 5 years beginning at age 20 |
| Cervical Cancer Screening | Annually beginning at age 18 |
| Mammograms | Starting at age 40 |
| Prostate Screening | Annually beginning at age 40 |
| Colorectal Cancer Screening | Every 5-10 years beginning at age 50 |
Immunizations – They’re Not Just For Kids Anymore!
Both Imagine! Medical Plans cover child and adult immunizations, as directed by your physician and AMA guidelines.
Telehealth
E-Visits
If you have a non-urgent medical condition at any time and you’re not sure what kind of care you need, an e-visit may be a good option for you. An e-visit is an online medical consultation with a Kaiser Permanente Advice Call Center Registered Nurse that’s available at no cost for select medical conditions like nausea/vomiting, pink eye, female UTI, sinus-related, constipation, diarrhea, and more.
How to Complete an E-Visit
- Log on to kp.org. Then, go to My Health Manager and then the Appointment Center.
- From there, choose the medical condition that best describes your symptoms.
- Answer the questions and click submit.
- An Advice Call Center Registered Nurse will respond within four hours of receiving your completed questionnaire.
Video Visits
Kaiser Permanente Colorado is now offering another convenient option to get care – Video Visits. Video Visits are a new way to get care that’s secure, convenient and personalized.
A Video Visit takes the place of an in-person visit at a Kaiser Permanente medical office. Your provider will work with you to determine if the care you need can be delivered in a Video Visit.
If you’re interested in Video Visits, speak to your provider. If you have questions about non-urgent symptoms or another aspect of your care, visit kp.org/myhealthmanager to email your Kaiser Permanente doctor.
Please note: Video Visits are not available to members who see physicians outside of Kaiser Permanente.
Dispatch Health
DispatchHealth provides On-Demand urgent care, in the comfort of your home, workplace, or other place of need. Requesting care is easy; call (303.500.1518) or simply use the mobile app or website (www.dispatchhealth.com) to begin the virtual triage process.